Gamification in Health Behavior Change Support Systems - A Synthesis of Unintended Side Effects

Gamification has become a popular and promising tool to positively impact the usage of health behavior change support systems (HBCSSs). Fun and engaging components are purposefully integrated in the design of HBCSSs in an effort to encourage users to employ the system in a more regular manner or over a longer period of time. Although extant research has made extensive efforts to understand the psychological and behavioral outcomes of gamification, its potential unintended side effects have been mostly neglected. We approached this gap by reviewing 33 articles on gamification in HBCSSs. We identified 16 potential unintended side effects in five categories. By taking a critical view, our research contributes to a more nuanced approach to gamification, which helps to understand how it can be utilized as a valuable tool for developers that motivates and does not harm users of HBCSSs.

[1]  Juho Hamari,et al.  Defining gamification: a service marketing perspective , 2012, MindTrek.

[2]  Reinout W Wiers,et al.  Attentional Bias Modification With Serious Game Elements: Evaluating the Shots Game , 2016, JMIR serious games.

[3]  Tyler Sax,et al.  Just a Fad? Gamification in Health and Fitness Apps , 2014, JMIR serious games.

[4]  Ashok Ranchhod,et al.  Gamifying Self-Management of Chronic Illnesses: A Mixed-Methods Study , 2016, JMIR serious games.

[5]  Mathijs F. G. Lucassen,et al.  Serious Games and Gamification for Mental Health: Current Status and Promising Directions , 2017, Frontiers in psychiatry.

[6]  Lennart E. Nacke,et al.  From game design elements to gamefulness: defining "gamification" , 2011, MindTrek.

[7]  Guo Song,et al.  Gamified Cognitive Bias Modification Interventions for Psychiatric Disorders: Review , 2018, JMIR mental health.

[8]  David Coyle,et al.  Gamification of Cognitive Assessment and Cognitive Training: A Systematic Review of Applications and Efficacy , 2016, JMIR serious games.

[9]  Alex Burdorf,et al.  A Blended Web-Based Gaming Intervention on Changes in Physical Activity for Overweight and Obese Employees: Influence and Usage in an Experimental Pilot Study , 2017, JMIR serious games.

[10]  Emily Seto,et al.  A game plan: Gamification design principles in mHealth applications for chronic disease management , 2016, Health Informatics J..

[11]  S. Ali Etemad,et al.  Keeping Users Engaged through Feature Updates: A Long-Term Study of Using Wearable-Based Exergames , 2017, CHI.

[12]  J. McGonigal.  Reality Is Broken: Why Games Make Us Better and How They Can Change the World , 2011 .

[13]  P. Barratt.  Healthy competition: A qualitative study investigating persuasive technologies and the gamification of cycling , 2017, Health & place.

[14]  Alberto M. Segre,et al.  Gamifying Accelerometer Use Increases Physical Activity Levels of Sedentary Office Workers , 2018, Journal of the American Heart Association.

[15]  Thomas Franke,et al.  I track, therefore I walk - Exploring the motivational costs of wearing activity trackers in actual users , 2019, Int. J. Hum. Comput. Stud..

[16]  Gary B. Wills,et al.  The Wheel of Sukr: A Framework for Gamifying Diabetes Self-Management in Saudi Arabia , 2015, EUSPN/ICTH.

[17]  Seiji Isotani,et al.  The Dark Side of Gamification: An Overview of Negative Effects of Gamification in Education , 2017, HEFA.

[18]  Helmut Hlavacs,et al.  Apps for life change: Critical review and solution directions , 2016, Entertain. Comput..

[19]  Rudy McDaniel,et al.  A taxonomy for digital badge design in medical technologies , 2016, 2016 IEEE International Conference on Serious Games and Applications for Health (SeGAH).

[20]  Ali Idri,et al.  A systematic review of gamification in e-Health , 2017, J. Biomed. Informatics.

[21]  Juho Hamari,et al.  "Working out for likes": An empirical study on social influence in exercise gamification , 2015, Comput. Hum. Behav..

[22]  Sebastian Lins,et al.  Gamifying Information Systems - a synthesis of Gamification mechanics and Dynamics , 2014, ECIS.

[23]  Fiona Fui-Hoon Nah,et al.  Gamification of Education: A Review of Literature , 2014, HCI.

[24]  Judy Drennan,et al.  Understanding how Gamification Influences Behaviour in Social Marketing , 2017 .

[25]  Heidi J. Wengreen,et al.  Gamification of Dietary Decision-Making in an Elementary-School Cafeteria , 2014, PloS one.

[26]  Sarim Siddiqui,et al.  Effective Behavioral Changes through a Digital mHealth App: Exploring the Impact of Hedonic Well-Being, Psychological Empowerment and Inspiration , 2018, JMIR mHealth and uHealth.

[27]  Oren Zuckerman,et al.  Deconstructing gamification: evaluating the effectiveness of continuous measurement, virtual rewards, and social comparison for promoting physical activity , 2014, Personal and Ubiquitous Computing.

[28]  Juho Hamari,et al.  Gamification in Crowdsourcing: A Review , 2016, 2016 49th Hawaii International Conference on System Sciences (HICSS).

[29]  Rüdiger Zarnekow,et al.  How Effective Is "Exergamification"? A Systematic Review on the Effectiveness of Gamification Features in Exergames , 2017, HICSS.

[30]  Juho Hamari,et al.  International Journal of Information Management Why Do People Use Gamification Services? , 2022 .

[31]  Hanna Hopia,et al.  Gamification in Healthcare: Perspectives of Mental Health Service Users and Health Professionals , 2016, Issues in mental health nursing.

[32]  A. Strauss,et al.  Basics of qualitative research: Grounded theory procedures and techniques. , 1993 .

[33]  Tae Wan Kim,et al.  More than just a game: ethical issues in gamification , 2016, Ethics and Information Technology.

[34]  Evan M. Forman,et al.  Promising technological innovations in cognitive training to treat eating-related behavior , 2017, Appetite.

[35]  Chrysanne Di Marco,et al.  Towards Personality-driven Persuasive Health Games and Gamified Systems , 2017, CHI.

[36]  Parisa Eslambolchilar,et al.  Gamification and Adherence to Web-Based Mental Health Interventions: A Systematic Review , 2016, JMIR mental health.

[37]  Ali Sunyaev,et al.  The influence of gamified workshops on students' knowledge retention , 2018, GamiFIN.

[38]  P. Krebs,et al.  Health App Use Among US Mobile Phone Owners: A National Survey , 2015, JMIR mHealth and uHealth.

[39]  Dylan S. Small,et al.  Effect of a Game-Based Intervention Designed to Enhance Social Incentives to Increase Physical Activity Among Families: The BE FIT Randomized Clinical Trial , 2017, JAMA internal medicine.

[40]  Juho Hamari,et al.  Does Gamification Work? -- A Literature Review of Empirical Studies on Gamification , 2014, 2014 47th Hawaii International Conference on System Sciences.

[41]  Stoyan R. Stoyanov,et al.  Gamification for health and wellbeing: A systematic review of the literature , 2016, Internet interventions.

[42]  David Coyle,et al.  Attrition from Web-Based Cognitive Testing: A Repeated Measures Comparison of Gamification Techniques , 2017, Journal of medical Internet research.

[43]  John Hansen,et al.  “The Heart Game”: Using Gamification as Part of a Telerehabilitation Program for Heart Patients , 2016, Games for health journal.

[44]  Oren Zuckerman,et al.  Embracing Cheating in Gamified Fitness Applications , 2015, CHI PLAY.

[45]  Yair Levy,et al.  A Systems Approach to Conduct an Effective Literature Review in Support of Information Systems Research , 2006, Informing Sci. Int. J. an Emerg. Transdiscipl..

[46]  Ashok Ranchhod,et al.  Guidelines for the Gamification of Self-Management of Chronic Illnesses: Multimethod Study , 2017, JMIR serious games.

[47]  Maged N Kamel Boulos,et al.  Exergames for health and fitness: the roles of GPS and geosocial apps , 2013, International Journal of Health Geographics.

[48]  Francisco Rebelo,et al.  A Review of Gamification for Health-Related Contexts , 2014, HCI.

[49]  Zaid Al-Fagih,et al.  Game On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study , 2016, JMIR serious games.

[50]  Harri Oinas-Kukkonen,et al.  A foundation for the study of behavior change support systems , 2012, Personal and Ubiquitous Computing.

[51]  J. Stinson,et al.  Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer , 2012, Journal of medical Internet research.

[52]  José Esteves.  The perils of gamification triviliazation: how and why gamification is failing to deliver loyalty , 2017 .

[53]  Gregory J Madden,et al.  The FIT Game: preliminary evaluation of a gamification approach to increasing fruit and vegetable consumption in school. , 2014, Preventive medicine.

[54]  Sami Hyrynsalmi,et al.  The Dark Side of Gamification: How We Should Stop Worrying and Study also the Negative Impacts of Bringing Game Design Elements to Everywhere , 2017, GamiFIN.

[55]  Rachel Fournier,et al.  Behavioral Economics, Wearable Devices, and Cooperative Games: Results From a Population-Based Intervention to Increase Physical Activity , 2016, JMIR serious games.

[56]  Zakkoyya H. Lewis,et al.  What's the Point?: A Review of Reward Systems Implemented in Gamification Interventions. , 2016, Games for health journal.

[57]  Tobias Mettler,et al.  Gamification applied for health promotion: does it really foster long-term engagement? A scoping review , 2018, ECIS.

[58]  Scott Thiebes,et al.  What's in the Game? Developing a Taxonomy of Gamification Concepts for Health Apps , 2018, HICSS.

[59]  M Househ,et al.  The Unintended Consequences of Social Media in Healthcare: New Problems and New Solutions. , 2016, Yearbook of medical informatics.

[60]  Harri Oinas-Kukkonen,et al.  Understanding persuasion contexts in health gamification: A systematic analysis of gamified health behavior change support systems literature , 2016, Int. J. Medical Informatics.

[61]  Vivian Hsueh-hua Chen,et al.  A social-cognitive approach to online game cheating , 2013, Comput. Hum. Behav..